嗳气症的病理生理机制初探  

Pilot study on pathophysiology mechanism of belching disorders

作　　者：孙晓敏[1,2] 柯美云[1] 王智凤[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院消化内科,100730 [2]上海交通大学附属第一人民医院松江分院消化内科

出　　处：《中华消化杂志》2013年第5期303-306,共4页Chinese Journal of Digestion

基　　金：“十一五”国家科技支撑计划（2007BA104801）;上海市卫生局资助项目（20114309）

摘　　要：目的联用高分辨率测压（HRM）和阻抗检测研究嗳气症的病理生理机制。方法10例嗳气症患者中男4例、女6例，年龄28～50岁，均接受HRM联合阻抗检测，分析静息、吞咽及嗳气时的食管动力学特点和可能的嗳气发生机制。结果10例患者中9例存在食管蠕动功能障碍，表现为非传导收缩、中断收缩、脱落收缩等非蠕动性收缩。3例患者下食管括约肌（LES）压力降低。1例患者LES松弛不全。10例患者中9例为胃上嗳气，表现为气体快速进入食管并在1s内快速反向从口排出。9例胃上嗳气患者中7例吸气时胸腔负压增加，上食管括约肌松弛，气体被吸入食管；2例咽部肌肉收缩，气体被逼人食管。所有的患者均通过腹肌和膈肌收缩，胃内压和食管压增高，将气体从口排出。结论本研究结果初步提示，嗳气症患者存在食管蠕动功能障碍，非特异性过度嗳气患者不存在频繁吞咽空气的情况，其典型暖气模式为胃上嗳气。Objective To investigate the pathophysiology mechanism in belching by using high resolution manometry combined with impedance monitoring. Methods Ten belching patients （four male and six female, ages ranged from 28 to 50 years） received high resolution manometry combined with impedance monitoring. The characters of esophageal motility at rest, swallowing and belching and the possible mechanism of belching were analyzed. Results Nine of 10 patients had esophageal peristaltic dysfunction, displaying as non-peristaltic contraction such as non-conduction contraction, interrupt contraction and dropping contraction. The pressure of the lower esophageal sphincter （LES） of three patients decreased. LES of one patient had incomplete relaxation. Nine of 10 patients were supragastic belching, in which air moved rapidly into esophagus and reversed exited from the mouth in one second. Among nine supragastic belching patients, the pleural pressure of seven patients increased during inspiration, upper esophageal sphincter relaxed and air was mistaken into the esophagus. The pharyngeal muscle contracted in two patients and the air was forced into esophagus. Of all the patients, intragastric and esophageal pressure increased through abdominal muscles and diaphragm contraction and air exited from the mouth. Conclusions The results of this study indicated that there was esophageal peristaltic dysfunction in belching patients. There was no frequently air swallowing in excessive belching patients, the typical belching model was supragastic belching.

关 键 词：嗳气 测压法 电阻抗 动力学 食管 

分 类 号：R57[医药卫生—消化系统]